Peres could begin rehab if he passes critical days ahead, expert says

“In a few weeks, a month, it will be clear if he has left the immediate dangerous situation and can be rehabilitated," say senior neurologist.

By JUDY SIEGEL-ITZKOVICH
Updated: SEPTEMBER 14, 2016 13:29
Shimon Peres (photo credit: REUTERS)
Shimon Peres
(photo credit: REUTERS)
If former president Shimon Peres’s condition remains stable and he passes the critical days ahead with no decline in his physical condition, he could begin rehabilitation in about a month, according to Dr. Tatiana Vander, a senior neurologist and head of the day rehabilitation unit at Herzfeld Rehabilitation Hospital in Gedera.
 
Vander told The Jerusalem Post on Wednesday that while she is not involved in the 93-year-old former president’s case, there are some positive signs.
“In a few weeks, a month, it will be clear if he has left the immediate dangerous situation and can be rehabilitated,” said Vander, whose hospital is part of the Kaplan Medical Center in Rehovot.
Peres in medically induced coma after major stroke
“If he reaches this stage and the family chooses to do so, we would be happy to admit him and do all we can for him. We have much experience and many resources,” said Vander.
 
The fact that Peres is 93 is a drawback, she said, but because he was in good mental and physical condition before his hemorrhagic stroke is good.
“I recently treated a 94-year-old man who was sedated and respirated but underwent rehabilitation and was able to talk and even walk. He is now back in his supportive-living geriatric home,” she said.
 
The fact that Peres’s doctors at Sheba Medical Center decided not to perform brain surgery at this time to drain the blood could be a good sign or a bad sign.
Either the damage to the brain was in a place where surgery would cause damage, or the neurosurgeons realized that the massive bleeding, which ended on its own after midnight Wednesday, could resolve itself on its own. “I support the Sheba doctors on their decision; they are very experienced.”
 
Within about a month, blood in the brain could break down and be absorbed. But if there was massive bleeding, the brain automatically suffers damage, because parts of the brain lacked oxygen-rich blood.
 
The fact that when sedation was reduced and his son-in-law Prof. Rafi Walden asked him to grip his hand and Peres in fact did so, is very positive, said Vander. “If he has shown any sign of communication, it is a good sign.”
 
A rehabilitation expert should -- and may already -- have been called to Peres’s bedside in the neurosurgical intensive care unit at Sheba to begin assessment of his case, she added.
 
“The questions to be considered over the coming weeks are how much damage was suffered, how the damage will be expressed and -- if he remains stable without complications -- if and how he can be weaned from the respirator and rehabilitated.
Intensive rehabilitation to restore functions include preventing infections and the use of physiotherapy, occupational therapy and speech therapy.
 
One can’t compare the situations of the late prime minister Ariel Sharon and Peres, even though Sharon was younger, because Sharon underwent numerous surgical interventions and never left his coma, which went on for years, she said.
 
Earlier in the day, Sheba director-general Prof. Yitzhak Kreiss said Peres passed the night “peacefully and his condition is still serious but stable.”
He was transferred from regular intensive care to the neurosurgical intensive care unit for treatment and followup. “We are in ongoing contact with the family in making decisions and have very good cooperation with them,” Kreiss said.
 
Walden thanked Sheba’s multidisciplinary medical team for their “correct decisions.” He called on all the Jewish People who “join us in prayers and hopes for his recovery.”
Dr. Yuli Treger, head of the Rehabilitation Society in the Israel Medical Association, noted that any serious stroke, which deprives parts of the brain of blood, can lead to a paralyzed arm or leg and the inability to walk, function independently or speak.
 
Every year, 15,000 Israelis suffer strokes. Between 30% and 50% of those who have a first stroke will have a second one during the first year, according to research, and the second one may be even more serious, he said.
 
“Unfortunately, there is no injection or pill that can restore the stroke victim to what he was before. He and those who rehabilitate him have to work hard to improve function. Many who survive a stroke suffer from depression and difficulty functioning on a routine basis or even leaving the house.
 
If the arm or leg is paralyzed, it affects the side opposite the location of the harm to the brain. Patients must carry out aerobic activity -- getting the heart and lungs to function vigorously -- on a daily basis. In addition to physical activity, the stroke victim must also “exercise” the mind with reading, playing with Lego, puzzles, computers or chess. Join a community center with activities for the elderly, said Treger.
 
Exercising, having a normal weight, not smoking, keeping diabetes in balance, bringing blood pressure to normal limits, relaxing and eating right is the best way to prevent oneself from getting a stroke in the first place.